Injuries, Restraints Raise Concerns Over Locked Juvenile Unit

The maximum security girls facility in the Pueblo Unit of the Solnit Hospital in Middletown.

The maximum security girls facility in the Pueblo Unit of the Solnit Hospital in Middletown. (Richard Messina / Hartford Courant)

JOSH KOVNER, jkovner@courant.com

The Pueblo unit, a locked treatment program for troubled girls in Middletown, is the subject of an intense debate over its effectiveness – heightened during the 19 days that a transgender girl whose movements were followed nationally was housed there.

On one side are child-welfare advocates, including lawyers for the 16-year-old transgender girl, who was moved to the Pueblo unit from an adult prison, and moved out after she was involved with three other girls in a fight July 12.

The clash ended with injuries to the girls and several staff members, allegations that some of the staff overreacted, and a deepening belief by the advocates and some youth officers who work at Pueblo that the unit opened too hastily in March and now operates in crisis mode. Jane Doe, as the transgender girl is known in court papers, is now housed alone in an unused boy's unit reopened for her at the Connecticut Juvenile Training School, just up the hill from Pueblo.

"First and foremost, these girls need treatment,'' said state Child Advocate Sarah Eagan.

A review of assault and restraint records at Pueblo by Eagan's office "raises significant questions about the ability of this facility to assess these girls and then meet their treatment needs," she said.

On the other side of the debate is the Department of Children and Families and Commissioner Joette Katz, who lobbied hard to get the $2.5 million in start-up money to open the unit in a renovated building on the grounds on the campus of the Solnit Center, formerly known as Riverview Hospital.

She said the staff-to-resident ratio was higher than the national average, Assistant Superintendent Krista Ramsey is a high-caliber leader of the unit, 11 of the 17 girls who have been at Pueblo since March have been successfully discharged, and that a proper balance has been struck between security and treatment. There are now six girls in the 12-bed unit.

"Pueblo has been everything we wanted it to be,'' Katz said in July. She said improvements have been made as needed and a broad assessment of Pueblo is set for September – at the six-month mark.

The genesis for Pueblo was the closing of Long Lane School for girls in Middletown in 2003. That left one locked program for girls in Connecticut — Journey House on the grounds of Natchaug Hospital in Mansfield. Katz argued before the legislature in 2013 that Pueblo was needed to provide secure treatment to a small number of girls who had failed, run away, or disrupted other programs. Advocates said a new locked unit wouldn't be needed if problems with treatment planning and overly long stays were addressed at Journey House. Katz won the funding needed to open Pueblo.

Before Pueblo opened, DCF secured the endorsements of national security consultants who toured the space and deemed it safe, Katz said.

With the debate over Pueblo intensifying four months into its operation, The Courant reviewed some facility records and interviewed DCF employees who work directly with the residents both at the Connecticut Juvenile Training School for boys and Pueblo, which is considered part of CJTS. The newspaper identified several issues and brought them to the advocates and DCF for response.

A high injury rate among and excessive work hours for the staff at Pueblo: At one point recently, six out of eight first-shift youth service officers were out on workers' compensation for restraint- and assault-related injuries. On second shift, at least three of the six youth officers were also out on injury leave at the same time. On third shift, the four youth officers on a few occasions were ordered to work 20-hour shifts. Supervisory staff at CJTS and Pueblo have had to fill in as direct-care workers to make up for the absences of the injured youth officers.

Assaults at Pueblo: DCF said there have been 25 staff "interventions," also known as restraints, at Pueblo since the unit opened in March. Each intervention was the result of some level of assaultive behavior. The actions were comprised of 11 restraints "that went to the floor" – the highest level of restraint. The other 14 were "standing" restraints, which include a staff member placing a hand on the shoulder of a girl to escort her to another location.

Questions about safety for staff and youth: Officers say that Pueblo is not as suicide-proof as it should be. There are blind spots in the bedrooms – small areas where a girl cannot be seen from the hallway. In July, one of the girls went into a blind spot and was able to tie a shirt around her neck. CJTS Superintendent William Rosenbeck said staffers quickly went into her room.

Lack of an isolation room and stairwells that are not covered by security cameras: The building contains two padded rooms with locking doors, but DCF turned one into a storage room and took the door off the other one to create a "reflection room" for a girls involved in an assault or in some other kind of crisis to cool off. The youth officers support the reflection room, but said one isolation room is needed for the occasions that a girl will not calm down. After the July 12 fight, and in response to workers' requests, DCF turned the storage room back into a padded isolation room. Also after the fight, DCF officials installed additional cameras to cover stairwells that had not been monitored before.

Katz's position is that the "Pueblo unit was highly stable before Jane Doe arrived and has been stable since she was transferred out."

Advocates were highly critical of Katz for singling Jane Doe out in a DCF press release on her transfer from Pueblo and the department's characterization of Doe in court as the most troublesome and assaultive teenager in DCF care.

Katz said she issued the press release because the youth's placement in and out of an adult prison without charges had drawn national attention, and to remain silent about the July 12 fight and the transfer could have been perceived as a cover-up by DCF.

Supervisory Assistant Public Defender James Connolly, one of Jane Doe's lawyers, said "the publicity around the treatment of Jane Doe doesn't change DCF's legal relationship with her. They are her statutory parent. The press release was just to say, 'See, we're right. She's a bad girl.' "

Katz said: "When we moved her to Pueblo, we were very hopeful. She had stabilized and Pueblo had its legs. We thought we could do this."

Katz said "other kids are being investigated [for the July 12 fight.] Jane Doe may not be the only one charged."

Although Katz said all the girls at Pueblo have tragic backgrounds, "not all the girls are similarly situated."

Rosenbeck acknowledged the high injury rate among youth service officers at Pueblo. He said workers' compensation cases "can be complex to manage" and that if an officer said he or she sustained an injury assisting in a restraint, "we respect that."

Katz said that at full staffing, four safety officers for six to eight girls on a shift is higher than the national average.

"The challenge is to always have the staff to cover the injuries. You are going to have injuries," Katz said, adding that the safety of the youth service officers and other staff is a top priority.

"If they don't feel safe, then no one will feel safe," said Katz.

But advocates such as Eagan, Connolly, and Abby Anderson of the Connecticut Juvenile Justice Alliance said the injury rate and the number of interventions suggest weaknesses in mediation protocols, approaches being used by staff, and the clinical treatment the girls are receiving.

"Why are incidents escalating to restraints as frequently as they are? Are psychologists or social workers on hand when the posturing starts?" said Eagan, who viewed a videotape of a period of time before, during and after the July 12 fight. "If a restraint occurs because a girl is refusing to go to her room, why does she have to go her room? Do the workers have the training and authority to sit with a girl in the corner in that situation?"

Eagan's office has requested a series of other videotapes from the Pueblo unit.

Katz said the direct-care workers do use techniques to keep confrontations from escalating, and that each restraint is looked at to see if a different approach could have been used. She said the three clinical staff members at Pueblo have fostered effective relationships with the girls. Katz said that if a clinician is needed at night and on weekends, professionals from CJTS are available.

Connolly countered that clinical staffing should be provided around the clock to prevent disruptions of treatment and build trust.

"They wait for a problem and then call a code blue, and staff from the training school comes running over,'' said Connolly, referring to Pueblo's radio signal for emergency backup. "And with no clinical staff assigned to the unit on weekends, there's no continuity to the treatment."

Anderson, Connolly and the rest of an advisory panel of experts who regularly meet at CJTS, recommended in July that DCF use Performance-Based Standards – an assessment program developed by the U.S. Department of Justice – to gauge CJTS and Pueblo.

Used by the juvenile-justice division of the Connecticut judicial system, the program looks at assaults, restraints, suicide attempts, conditions of confinement, and other operational details, and provides twice yearly audits.

Katz rejected the recommendation. She said CJTS is nationally accredited by the American Correctional Association, which requires adherence to more than 300 policies and standards. She said the association's audit once every three years is sufficient because DCF closely monitors CJTS and tracks a large amount of data. She said DCF will be seeking accreditation for Pueblo.

Rosenbeck said that DCF considers Pueblo to be suicide-proof, with fixtures in the bathrooms – shower spouts and most hinges – that are designed to impede suicide attempts. He said the blind spots in the bedrooms, a sore point with youth service officers, are there intentionally, to allow girls a bit of privacy in their rooms. He said that as soon as staffers cannot see a girl on her bed, they go into the room.

But some DCF employees said adjustments that DCF has had to make on the fly – with the isolation rooms, adding cameras, adding suicide-proof hinges in the bathrooms — should have been done before Pueblo opened.